Question

Case Study, Chapter 59, Assessment and Management of Problems Related to Male Reproductive Processes 1. Joe Smith, a 55-year-old patient, is admitted to the surgical unit after robotic-assisted laparoscopic radical prostatectomy with nerve sparring for early stage cancerous tumor confined to the prostate. The client has six small incisions in the abdomen with small 4x4 dressings with clear dressing dry and intact. The client has a JP drain in place with clear, red-colored drainage with 50 mL present and an indwelling urinary catheter draining clear, red-colored urine. The surgeon ordered ketorolac (Toradol) for pain management and belladonna and opiate (B&o) suppository every 8 hours, as needed, for bladder spasms. (Learning Objective #5) a. What nursing care should be provided to the patient in the immediate b. For what potential complications should the nurse observe, and what actions c. The surgeon removes the JP drain the next day and discharges the patient with the postoperative period? should the nurse take if the complication develops? indwelling urinary catheter to a leg bag. What discharge instructions should the nurse provide the patient? What follow-up care is anticipated for him? 2. Joe Smith, a 67-year-old man, is admitted with the diagnosis of adenocarcinoma of the penis. He presents with painless wartlike growth on the skin of the glans of the penis (Learning Objective #7) Explain the pathophysiology of cancer of the penis. What are the early and late manifestations of cancer of the penis? What are the management goals for cancer of the penis? a. b. c.

Answer 1

1a) The immediate post operative nursing care are

• Monitoring vital signs
• Keeping patient nil by mouth until order and supporting with IV fluids as per order.
• Pain management as per order
• Monitoring intake and output of the patients
• JP drain care has to be done to assess the drainage amount
• Urinary catheter to be secured to prevent accidental dislodging
• Bladder spasm to be treated with medications

b)The potential complication the nurse can expect is bleeding post operatively.Immediately Report and administer drugs to prevent massive hemmorhage ax per order.Strict monitoring of patient vitals as the BP tends to fall down rapidly.

The other complications are incontinence ,impotence,deep vein thrombosis

c)The following discharge instruction to be provided

• Take medications on time
• Proper urinary catheter care to prevent infections
• Report immediately If any pain,severe bleeding, infection or swelling at the operated site,nausea ,vomiting, hives,fever,calf or thigh pain, if urine stops draining
• Continue using incentive spirometry to avoid respiratory infection
• Constipation us expected do increase fluid in diet
• Follow a healthy diet (avoid rice,noodles,high fibre dirt,very spicy foods ,fast foods,street foods
• No alcohol and smoking
• Mild activities and exercises like walk is encouraged .No strenuous exercises for four to six weeks
• Avoid driving
• Proper personal hygiene to be maintained
• Follow up at one to two weeks to remove catheter after investigation and examination
• PSA  test after three months and later every three to 12 months as a long term care.

2a) Pathophysiology

Age (65years), Wart forms the risk factor》》 infects the skin layer in the penile area》》slow degradation of cells mainly squamous cells》》resulting in Ca penile region

b)Early and late manifestation

• Rash
• Redness
• Pain or tender to touch
• Wart doesn't heal for more than four weeks
• Phimosis
• Change of penile skin colour
• High grade fever
• Foul discharge from the penile area

c)Management

• Surgical management to cease spreading of cancer (Gould operation,wide local excision, surgery,circumcision ,penectomy)
• Radiation therapy
• Chemotherapy

Goals

• Stop smoking
• Regular follow up and check ups
• Paraphimosis and phymosis as a prevention strategy
• HPV vaccines
• Use of contraceptive devices like condoms will be a protection against HPV  virus

Answer 2